| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,695 |
1,426 |
$395K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,632 |
971 |
$178K |
| D1120 |
Prophylaxis - child |
3,881 |
3,305 |
$156K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,533 |
2,001 |
$138K |
| D1206 |
Topical application of fluoride varnish |
5,169 |
4,354 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,362 |
1,120 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
347 |
244 |
$67K |
| D1351 |
Sealant - per tooth |
1,912 |
678 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
585 |
351 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,814 |
1,620 |
$57K |
| D0330 |
Panoramic radiographic image |
641 |
577 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
897 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,770 |
1,518 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
878 |
725 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,043 |
887 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,241 |
1,070 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
222 |
$23K |
| D1110 |
Prophylaxis - adult |
234 |
216 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
211 |
186 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
16 |
$4K |
| D2950 |
|
13 |
12 |
$2K |
| D9920 |
|
49 |
49 |
$2K |
| D1354 |
|
184 |
36 |
$1K |